螺旋CT扫描诊断急性阑尾炎的应用价值

目的：探讨螺旋CT扫描诊断急性阑尾炎的应用价值。方法：分析我院拟诊急性阑尾炎26例螺旋CT资料。结果：均经手术证实，单纯性阑尾炎6例，急性化脓性阑尾炎12例，阑尾穿孔伴局部腹膜炎4例，阑尾脓肿2例，伴发弥漫性腹膜炎1例，局部出现肿块1例。阑尾形态正常1例，周围无炎症表现；右侧输尿管结石1例。CT扫描，急性阑尾炎多有阑尾增粗、壁增厚、阑尾腔积气、阑尾粪石、阑尾壁强化缺损等；同时可有阑尾周围炎性病变、积液及反射性肠淤胀等。结论：螺旋CT有助于急性阑尾炎的诊断及鉴别诊断。     

32层螺旋CT三维重组在急性阑尾炎诊断及鉴别诊断中的价值

目的：探讨32层螺旋CT三维重组诊断急性阑尾炎的临床应用。方法：搜集60例临床拟诊急性阑尾炎的病例,采用32层螺旋CT进行扫描,以1.25mm层厚行薄层多平面容积重组图像后处理,总结分析其CT表现,并将诊断结果与手术及病理结果进行对照。结果：60例患者中,诊断为急性阑尾炎54例,右侧腹股沟疝1例,右侧输尿管下段结石1例,胆囊炎1例,结肠肿瘤1例,假阴性2例。其中CT表现为阑尾水肿、增粗、管壁增厚者52例,阑尾腔内肠石10例,阑尾周围炎45例,回盲部壁增厚12例,阑尾脓肿2例,阑尾穿孔2例,其中1例并发腹膜炎及麻痹性小肠梗阻。结论：急性阑尾炎有典型的CT表现,32层螺旋CT三维重组及图像后处理技术能从不同角度显示阑尾及其周围情况,在急性阑尾炎的诊断和鉴别诊断中,有较高的临床应用价值。     

多层螺旋CT对急性阑尾炎的诊断

目的 分析急性阑尾炎的多层螺旋CT(MSCT)诊断价值.方法 对58例经手术、临床证实的急性阑尾炎的阑尾大小、形态及盲肠周围改变等CT资料进行回顾性分析.结果 38例显示异常阑尾(肿大增粗、壁增厚、腔内结石积液等),46例显示阑尾周围炎性改变(阑尾周围脂肪内斑点状及条纹状模糊影、腹腔少量积液、右侧侧锥筋膜增厚、腰大肌前缘模糊、右侧肾周筋膜增厚),腔外气体2例,腔外结石1例,局限性盲肠壁增厚12例.结论 MSCT在急性阑尾炎的诊断中有重要的价值.     

急性阑尾炎的CT检查与诊断

目的:探讨急性阑尾炎的CT诊断及其应用价值.材料和方法:33例经手术病理和(或)穿刺活检证实的阑尾炎CT资料,就CT表现、分型和诊断价值加以分析.结果:33例临床疑诊急性阑尾炎患者中,CT诊断为急性阑尾炎6例(18.18%);急性阑尾炎并阑尾周围炎10例(30.30%);急性阑尾炎伴阑尾穿孔3例(9.09%);阑尾脓肿10例(30.30%)和炎性肿块4例(12.31%).急性阑尾炎的直接CT表现有:阑尾增粗(直径＞6mm),壁增厚;阑尾结石.间接表现则有:阑尾周围脂肪组织内条索状影;阑尾周围间隙内渗液及游离气体影;阑尾脓肿或炎性肿块等.结论:对临床疑似病例做螺旋CT检查有助于诊断或排除急性阑尾炎,并可对阑尾脓肿、炎性包块与回盲部肿瘤作出鉴别.     

非增强螺旋CT扫描对急性阑尾炎的诊断价值

目的 评价非增强螺旋CT扫描对急性阑尾炎的诊断价值。资料与方法 对115例临床怀疑急性阑尾炎患者作非增强螺旋CT扫描，不口服或结肠内灌注对比剂，层厚10mm，Pitch1，扫描范围从L3椎体至耻骨联合。CT诊断急性阑尾炎的标准包括阑尾增粗横径超过6mm，或阑尾结石同时伴有阑尾周围的炎性改变。CT诊断结果与手术、病理或临床随访结果进行对照。结果 CT发现56例真阳性，49例真阴性，7例假阴性和3例假阳性。CT诊断急性阑尾炎的敏感性为89％，特异性为94％，准确性为91％，阳性预测值为95％，阴性预测值为88％。49例无阑尾炎患者中，CT发现其他病变22例(45％)。结论 非增强螺旋CT扫描，能快速、准确地诊断有无急性阑尾炎，而且还能发现除阑尾炎以外的其他各种病变。     

螺旋CT对急性阑尾炎的诊断价值

目的：探讨螺旋CT对急性阑尾炎的诊断价值。方法：搜集CT提示或诊断为阑尾炎并经手术病理证实的34例患者，回顾性分析其CT征象。结果：15例CT表现为阑尾增粗，壁增厚；26例表现为右下腹或盆腔炎性改变（如周围脂肪密度增高、肠周积液、蜂窝织炎、脓肿、腔外气体、淋巴结肿大、相邻肠管增厚、阑尾结石或粪石）；6例盲肠末端有局限性增厚；4例右侧腰大肌影模糊。结论：CT诊断急性阑尾炎有独到之处，能为临床合理治疗提供帮助。     

64排螺旋CT诊断急性阑尾炎的价值

目的探讨64排螺旋CT对急性阑尾炎的诊断价值。方法收集本院46例临床上拟诊急性阑尾炎的病例。术前均采用Philips Brilliance 64排螺旋CT进行常规扫描及多层面重组。其中12例患者行双期增强扫描,总结分析,并将CT表现与手术病理结果作比较。结果在46例急性阑尾炎患者中,有32例CT显示阑尾异常增粗、壁增厚,42例显示阑尾周围渗出性炎性改变(表现阑尾周围脂肪间隙斑片状及条索状模糊影),6例阑尾周围脓肿形成,另外,阑尾内结石15例,腹腔少量积液8例,30例筋膜局限性增厚,局限性盲肠壁增厚6例,腹膜炎及低位肠梗阻4例,腔外游离气体2例。结论 64排螺旋CT扫描对急性阑尾炎的诊断具有较高价值。     

MSCT诊断异位急性阑尾炎的临床价值分析

目的探讨多层螺旋CT(MSCT)对异位急性阑尾炎的的诊断价值。方法搜集26例临床首诊非急性阑尾炎,而经MSCT诊断为异位急性阑尾炎的病例,分析其CT表现及特征,并将诊断结果与手术及病理结果进行对照分析。结果 26例异位阑尾炎患者中,高位阑尾炎5例,盆腔阑尾炎20例,反向转位阑尾炎1例,其中1例为右侧腹股沟疝合并急性阑尾炎。CT表现直接征象为异位的阑尾水肿,增粗、管壁增厚,阑尾腔内粪石,间接征象为阑尾周围炎,肠系膜增厚,肠系膜根部淋巴结肿大。所有阑尾炎病例中,CT诊断为单纯性阑尾炎7例,化脓性阑尾炎19例,并阑尾腔内肠石6例,均行手术切除,与病理结果一致。结论异位急性阑尾炎有典型的CT表现,MSCT的平扫及图像后处理技术的联合应用,能直观地显示异位的阑尾的位置、形态及病理改变,在对异位急性阑尾炎的快速、准确的诊断中,有重要的临床应用价值。     

多层螺旋CT与超声对急性阑尾炎患者的临床诊断价值

目的比较分析多层螺旋CT与超声对急性阑尾炎患者的临床诊断价值。方法选取我院收治的63例急性阑尾炎患者作为研究对象,分别进行多层螺旋CT与超声检查,将检查结果与手术病理结果相比较,分析两者的临床诊断价值。结果与手术病理比较,多层螺旋CT对阑尾结构完整可辨、阑尾结构难辨、阑尾结构不清、团块等各型的诊断符合率分别为95.24%、80.00%、100.00%、100.00%。超声的诊断符合率分别为83.33%、66.67%、75.00%、100.00%。多层螺旋CT的总诊断符合率明显高于超声,多层螺旋CT与超声对急性单纯性阑尾炎的诊断符合率分别为100.00%、59.46%。急性化脓性阑尾炎的诊断符合率分别为75.00%、50.00%,急性坏疽性阑尾炎的诊断符合率均为100.00%。多层螺旋CT的诊断符合率明显高于超声,尤其是对急性单纯性阑尾炎的诊断符合率明显高于超声,差异具有统计学意义(P0.05)。结论多层螺旋CT应用于急性阑尾炎的诊断及分型,与临床病理诊断符合率高于超声。典型的CT征象为阑尾直径6mm、阑尾及周围肠壁增厚、存在积液等,为急性阑尾炎的诊断提供参考。     

多排螺旋CT在不典型急性阑尾炎诊断中的应用

目的探讨多排螺旋CT在不典型急性阑尾炎诊断中的意义。方法对56例不典型急性阑尾炎患者CT影像、治疗结果进行回顾性分析。结果 56例中,男20例,女36例,年龄17～88岁,平均(51.5±15.7)岁。发病时间1 h～7 d。螺旋CT均显示阑尾图像。CT影像表现为阑尾水肿增粗、管壁增厚33例,其中23例伴有阑尾周围渗出、积液。9例阑尾周围脓肿,5例阑尾腔内发现肠石。15例发现回盲部肠壁增厚,2例发现升结肠肿物。5例显示正常阑尾影像,其中2例发现右附件肿物,2例小肠节段性肠壁增厚,1例肠系膜淋巴结肿大。CT扫描结合临床诊断急性阑尾炎51例,行手术治疗47例,均经病理组织学检查证实。5例排除阑尾炎。结论多排螺旋CT阑尾影像特征对不典型急性阑尾炎诊断和治疗选择有重要价值。     

Incidence of acute appendicitis in patients with equivocal CT findings

OBJECTIVE: The purpose of our study was to determine the incidence of acute appendicitis in patients for whom the CT interpretation is deemed equivocal. MATERIALS AND METHODS: Of 1,344 patients referred for CT with suspected appendicitis between January 1998 and December 2002, 172 patients were identified in whom the radiographic findings were equivocal. Two radiologists reviewed the equivocal CT cases, reassessing appendiceal size and the presence of right lower quadrant stranding, fluid, or an appendicolith. The reviewers' findings were correlated with surgical pathology reports and clinical follow-up. RESULTS: Fifty-three (31%) of 172 patients with indeterminate findings on CT scans were subsequently diagnosed with appendicitis. For reviewers 1 and 2, respectively, appendicitis was present in five (14%) of 36 and six (13%) of 47 patients who had isolated appendiceal diameter less than 9 mm, and in 11 (52%) of 21 and in 10 (50%) of 20 patients who had isolated appendiceal dilatation equal to or greater than 9 mm. If a normal diameter appendix (< 6 mm) was visualized in a patient who had right lower quadrant stranding or fluid, appendicitis was present in only one (17%) of six and in four (27%) of 15 patients for reviewers 1 and 2, respectively. If the appendix could not be identified but there was right lower quadrant stranding or fluid, appendicitis was present in seven (37%) of 19 and in eight (53%) of 15 patients. CONCLUSION: Appendicitis is encountered in about 30% of patients with equivocal findings on CT, and the diagnosis should be considered in most of these patients if they are appropriately symptomatic. However, when the appendix measures less than 9 mm alone, the likelihood of appendicitis is much smaller.     

Chronic inflammatory appendiceal conditions that mimic acute appendicitis on helical CT

OBJECTIVE: Acute appendicitis is commonly diagnosed on CT, but chronic appendiceal processes can mimic acute appendicitis. The purpose of this study was to identify the frequency of these alternative conditions and their findings on helical CT. CONCLUSION: Chronic inflammatory conditions other than acute appendicitis were found in 9% of patients who underwent surgery after CT findings were interpreted as suspicious for appendicitis. These inflammatory conditions were indistinguishable from acute appendicitis when we used either primary or secondary CT signs.     

儿童急性阑尾炎的CT表现及其评价

目的：探讨儿童急性阑尾炎的CT表现及其诊断价值。方法：回顾性分析本院2007年1月～2008年12月经手术和病理证实的55例小儿急性阑尾炎的临床和CT资料,总结其CT表现特点和临床应用价值。结果：55例急性阑尾炎中,卡他型12例,化脓型25例,坏疽型18例。CT表现为阑尾肿胀增粗（37/55）;阑尾腔内肠石（35/55）;阑尾腔内积气（17/55）;阑尾穿孔并周围脓肿形成（18/55）;阑尾周围组织密度不均匀升高（19/55）;相邻盲肠壁增厚（24/55）;腹水（11/55）;肠梗阻（5/55）;其它还有肝脓肿、NEC等并发症形成。结论：儿童急性阑尾炎的CT表现具有一定特点,CT检查可显示阑尾及其周围组织结构的病理改变,为临床明确诊断提供客观依据,尤其适用于儿童。     

CT对不典型阑尾炎的诊断价值

目的探讨CT对症状不典型急性阑尾炎的诊断价值。方法收集临床首诊未考虑阑尾炎,而经手术和病理证实的阑尾炎病例23例,对其CT表现进行观察分析。结果有11例表现为阑尾增粗,肠壁增厚;2例表现为右下腹脓肿;2例盲肠周围可见少量游离气体影;3例女性患者表现为盆腔脓肿;4例表现为盲肠及回肠肠壁增厚,周围渗液;1例伴有小肠梗阻。其中6例阑尾内可见结石。结论 CT能清楚显示阑尾的位置、形态以及周围组织的关系,对不典型阑尾炎的临床诊断,具有较高价值。     

Enhanced CT in the diagnosis of acute appendicitis to evaluate the severity of disease: comparison of CT findings and histological diagnosis

PURPOSE: To assess the potential of CT in evaluating the histological severity of acute appendicitis in comparison with surgical and pathological findings. METHOD: The CT images of 75 patients with surgically proven appendicitis, including 10 cases of catarrhal, 34 of phlegmonous, and 31 of gangrenous appendicitis, were retrospectively analyzed for the following five CT findings: (1) hazy periappendiceal densities, (2) enlarged appendix, (3) increased enhancement of the appendiceal wall, (4) increased enhancement of the periappendiceal intestinal wall, and (5) deficiency of the appendiceal wall. By comparing all the CT findings and the pathological severity of appendicitis (catarrhal, phlegmonous, and gangrenous), the prevalence of the five CT findings was calculated for each pathological category. RESULTS: Abnormal CT findings were noted in only one case of catarrhal appendicitis. Increased enhancement of the appendiceal wall was observed in all 29 cases of phlegmonous appendicitis (100%), but in only 66.7% (18 cases) of gangrenous appendicitis. Deficiency of the appendiceal wall was more frequently observed in gangrenous (19/27, 70.4%) than phlegmonous appendicitis (4/29, 13.8%). CONCLUSION: Findings of enhanced CT provide useful information in evaluating the pathological severity of acute appendicitis.     

Rare benign and malignant appendiceal lesions: spectrum of computed tomography findings with pathologic correlation

Although acute appendicitis is the most common disease of the appendix, the appendix can be involved by a wide range of diseases. Diseases other than acute appendicitis may produce signs and symptoms indistinguishable from those of acute appendicitis. Computed tomography (CT) can provide important information for diagnosis and evaluation of appendiceal diseases. The various CT and histologic features of appendiceal benign and neoplastic diseases are discussed, illustrated, and correlated in this article. Radiologists need to understand the full spectrum of appendiceal abnormalities, their underlying pathologic changes, and associated CT imaging findings.     

Primary neoplasms of the appendix manifesting as acute appendicitis: CT findings with pathologic comparison

PURPOSE: To evaluate the computed tomographic (CT) findings in patients with acute appendicitis related to an underlying appendiceal neoplasm. MATERIALS AND METHODS: Clinical and pathologic data obtained over a 10-year period in 65 patients with primary appendiceal neoplasms were reviewed. Preoperative CT studies in patients who presented clinically with symptoms of acute appendicitis were analyzed retrospectively and in consensus by three radiologists. The appendix was evaluated on CT scans for morphology, location, presence of calcification, maximal diameter, and wall thickness. RESULTS: Twenty-six (40%) of the 65 patients with appendiceal neoplasms had presented with symptoms of acute appendicitis. Preoperative CT studies available in 22 patients showed increased appendiceal diameter, wall thickening, and periappendiceal fat stranding in 22 (100%), 22 (100%), and 21 (95%) patients, respectively. The appendiceal diameter was greater than 15 mm (mean diameter, 2.9 cm) in 19 patients (86%). Morphologic changes of concern for neoplasm were present in 19 patients (86%) and included cystic dilatation in nine patients and presence of a soft-tissue mass without dilatation in 10 patients. An appendiceal diameter greater than 15 mm and/or a morphologic abnormality were present in 21 of 22 cases (95%). CONCLUSION: CT findings strongly suggest the presence of underlying neoplasm in the majority of patients with secondary appendicitis.     

The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT

PURPOSE: To evaluate the most useful findings to look for in diagnosing acute appendicitis on contrast-enhanced helical CT. MATERIAL AND METHODS: Appendiceal helical CT scans with intravenous contrast administration (abdomen, 7-mm collimation; abdominopelvic junction, 5-mm collimation) of 71 patients with surgically proven acute appendicitis and 167 patients with alternative diagnoses were reviewed retrospectively. Three radiologists analyzed the following parameters: enlarged appendix (>6 mm in diameter), appendiceal wall thickening, appendiceal wall enhancement, no identification of the appendix, appendicolith(s), appendiceal intraluminal air, intramural air, extraluminal air, periappendiceal fat stranding, extraluminal fluid, phlegmon, abscess, lymphadenopathy, segmental terminal ileal wall thickening, focal cecal apical thickening, focal colonic wall thickening, and segmental colonic wall thickening. The features that best distinguished appendicitis from alternative diagnoses were selected with stepwise logistic regression analysis. RESULTS: Nine CT findings distinguished acute appendicitis from alternative diagnoses (P < 0.05): enlarged appendix (R = 0.739), appendiceal wall thickening (R = 0.525), periappendiceal fat stranding (R = 0.414), appendiceal wall enhancement (R = 0.404), focal cecal apical thickening (R = 0.171), appendicolith(s) (R = 0.157), extraluminal air (R = 0.050), intramural air (R = 0.043), and phlegmon (R = 0.030). Enlarged appendix (sensitivity, 93%; specificity, 92%), appendiceal wall thickening (sensitivity, 66%; specificity, 96%), periappendiceal fat stranding (sensitivity, 87%; specificity, 74%), and appendiceal wall enhancement (sensitivity, 75%; specificity, 85%) showed the statistically most significant association with acute appendicitis. CONCLUSION: On 5-mm-section contrast-enhanced helical CT examinations, enlarged appendix, appendiceal wall thickening, periappendiceal fat stranding, and appendiceal wall enhancement were the most useful findings for diagnosing acute appendicitis.     

Acute appendicitis: comparison of helical CT diagnosis focused technique with oral contrast material versus nonfocused technique with oral and intravenous contrast material

PURPOSE: To compare the diagnostic accuracy of focused helical computed tomography (CT) with orally administered contrast material with that of nonfocused helical CT with orally and intravenously administered contrast material. MATERIALS AND METHODS: After receiving oral contrast material, 228 patients with clinically suspected appendicitis underwent focused appendiceal CT (5-mm section thickness, 15-cm coverage in the right lower quadrant). Immediately thereafter, helical CT of the entire abdomen and pelvis was performed following intravenous administration of contrast material (abdomen, 7-mm section thickness; pelvis, 5-mm section thickness). Studies were separated and independently interpreted by three observers who were blinded to patient names. Diagnoses were established by means of surgical and/or clinical follow-up findings. RESULTS: Fifty-one (22.4%) of 228 patients had acute appendicitis. Readers diagnosed appendicitis with 83.3%, 73.8%, and 71.4% sensitivity and 93.0%, 92.3%, and 97.9% specificity with focused nonenhanced appendiceal CT. Readers diagnosed appendicitis with 92.9%, 92.9%, and 88.1% sensitivity and 93.7%, 95.1%, and 96.5% specificity with nonfocused enhanced CT. Summary areas under the receiver operating characteristic curve estimates for focused nonenhanced and nonfocused enhanced CT were 0.916 and 0.964, respectively; the differences were statistically significant (P <.05) for two of three readers. All readers demonstrated higher sensitivities for detecting the inflamed appendix with nonfocused enhanced CT. Appendicitis was missed with focused CT in two patients whose inflamed appendix was not included in the imaging of the right lower quadrant. All readers were significantly more confident in diagnosing alternative conditions with nonfocused enhanced CT. CONCLUSION: Diagnostic accuracy of helical CT for acute appendicitis improved significantly with use of intravenous contrast material.